Pandemic Flu Workshop Slide Pack


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Pandemic Flu Workshop Slide Pack

  1. 1. WELCOME Pandemic Flu - Preparing Your Business A one-day workshop held at the Royal Society of Medicine • Thursday 11 September 2008 Pandemic influenza Dr Quentin Sandifer Deputy Regional Director of Public Health, NHS South East Coast and Honorary Clinical Senior Lecturer, University of Kent Dr James Sedgwick Consultant in Communicable Disease Control, Kent Health Protection Unit and Honorary Senior Lecturer, University of Kent September 2008 1
  2. 2. Aims of the workshop To raise awareness of the threat and consequences of an influenza pandemic and to highlight the associated major issues for business Pandemic influenza Session 1 Dr James Sedgwick Consultant in Communicable Disease Control Kent Health Protection Unit Honorary Senior Lecturer University of Kent September 2008 2
  3. 3. Content 1. Science (seasonal, avian & pandemic flu) 2. Impact of pandemic flu 3. Public sector response to pandemic flu Seasonal flu What is flu? • Viral respiratory infection • Highly infectious (secondary cases >2) • Incubation period (time from exposure to onset) 1-3 days • Period of infectivity 3-5 days from onset • Lasts 2-7 days (usually self-limiting) • Can be serious – complications (eg, bronchitis, pneumonia) esp. in those with underlying disease (lung/heart) and elders • Infection confers immunity to that strain • Causes 3,000 - 4,000 deaths in non-epidemic (normal) years (mostly in elders) 3
  4. 4. Consultation rate for flu-like illness, 1988-2008 Source – HPA Source: CDC / Dr Erskine; L Palmer; Dr ML Martin 4
  5. 5. Flu viruses and antigenic changes Flu A viruses • infect birds and other animals (eg, pigs, horses) as well as humans • cause ‘ordinary’ seasonal flu epidemics and all pandemics • undergo frequent changes in surface antigens or proteins - Minor changes - antigenic drift • result in seasonal flu each winter - Major changes - antigenic shift • mutation or by ‘reassortment’ between viruses • potential pandemic strains (population little immunity) Flu B viruses • infect humans only • no pandemic potential 5
  6. 6. Flu A virus reassortment (possible pandemic strain) Migratory water birds Domestic poultry 6
  7. 7. Understanding pandemic flu Epidemic • serious outbreak in a single community, population or region Pandemic • worldwide epidemic Flu pandemics are worldwide epidemics of a newly emerged strain of flu • which passes easily from person to person and • to which few, if any, people have immunity Iowa State gymnasium, converted into hospital, 1918 flu pandemic 7
  8. 8. What will a flu pandemic mean for UK? Pandemics occur unpredictably, not necessarily in winter Great variations in • mortality, • severity of illness and • pattern of illness or age of most severely affected Rapid surge in number of cases over brief period of time (weeks) Tend to occur in waves – subsequent waves may be more or less severe (“weeks or months later”) Intense pressure on health (and other) services Disruption to many aspects of daily life Avian flu – what is it? Contagious disease caused by flu A viruses Can affect all bird species esp migratory wildfowl (eg, ducks) Particularly devastating among domestic poultry (high bird death rate) Spreads through droplet inhalation or contact with droppings • migratory wildfowl • live bird markets Virus can survive for prolonged periods in the environment People usually infected through close contact with live infected birds Transmission from birds to people rare Transmission from person to person extremely rare 8
  9. 9. Cases of avian flu in humans Year Strain Country Confirmed Confirmed human cases human deaths 1997 A/H5N1 Hong Kong 18 6 1998 A/H9N2 China 6 0 1999 A/H9N2 Hong Kong 2 0 2002 A/H7N2 USA 2 0 2003 A/H5N1 Hong Kong 2 1 2003 A/H7N3 Canada 2 0 2003 A/H7N7 Netherlands 89 1 2003 A/H9N2 Hong Kong 1 0 2006 A/H7N3 UK 1 0 2007 A/H9N2 Hong Kong 1 0 2007 A/H7N2 UK 2 0 2003-2008 A/H5N1 Worldwide 385 243 “Outbreaks caused by the H5N1 strain are presently of the greatest concern for human health.” World Health Organization, 29 January 2004 Data up to 4 July 2008 9
  10. 10. Content 1. Science (seasonal, avian & pandemic flu) 2. Impact of pandemic flu 3. Public sector response to pandemic flu History of flu pandemics 1580 to 1900: 28 flu pandemics 20th Century pandemics: UK deaths Global deaths Year Strain Name (confirmed) (estimated) 1918-19 H1N1 ‘Spanish’ flu 250,000 20-40 million 1957-58 H2N2 ‘Asian’ flu 33,000 1 million 1968-69 H3N2 ‘Hong Kong’ flu 30,000 1 million 10
  11. 11. Health impact (population 60,000,000) Clinical cases @ Clinical cases @ Deaths @ Deaths @ Period 25% 50% 0.37% of 25% 2.5% of 50% Week 1 15,000 30,000 56 750 Week 2 30,000 60,000 111 1,500 Week 3 120,000 240,000 444 6,000 Week 4 465,000 930,000 1,721 23,250 Week 5 1,590,000 3,180,000 5,883 79,500 Week 6 3,240,000 6,480,000 11,988 162,000 Week 7 3,180,000 6,360,000 11,766 159,000 Week 8 2,145,000 4,290,000 7,937 107,250 Week 9 1,455,000 2,910,000 5,384 72,750 Week 10 1,125,000 2,250,000 4,163 56,250 Week 11 780,000 1,560,000 2,886 39,000 Week 12 390,000 780,000 1,443 19,500 Week 13 240,000 480,000 888 12,000 Week 14 135,000 270,000 500 6,750 Week 15 105,000 210,000 389 5,250 All Weeks 15,000,000 30,000,000 55,500 750,000 Staff absence from work Staff will be absent from work for a variety of reasons: 1. if ill with flu (absent for about a week) 2. if ill with other medical problems 3. to care for children or other family members who are ill (or bereavement) 4. to care for (well) children because of the closure of schools and childcare settings 5. if employers have advised them to work from home or they have practical difficulties getting to work (eg, fuel shortage) 6. due to fear of infection or taking home infection to their household Large organisations should plan for absence of up to 15- 20% at peak Small businesses should plan for up to 30-35% at peak 11
  12. 12. Other issues to consider Staff absence Schools’ closures Fuel (domestic, businesses, public transport) Food Vulnerable individuals Panic Excess deaths Economy Content 1. Science (seasonal, avian & pandemic flu) 2. Impact of pandemic flu 3. Public sector response to pandemic flu 12
  13. 13. Pandemic preparedness and response Reduce impact through: • Surveillance (WHO, European, HPA) • Diagnosis • Public health interventions • Antiviral drugs • Vaccines (once they become available) Alert levels – surveillance WHO international phase of pandemic alert UK pandemic alert level 13
  14. 14. Health response Public health / hygiene advice Self care Flu Line Antivirals (‘flu friend’) Referral to hospital for some (under 1s, complications) Vaccination 14
  15. 15. Public health interventions Personal interventions Basic measures to reduce the spread of infection • Hand washing: washing hands frequently with soap and water reduces the spread of the virus from the hands to the face, or to others • Respiratory hygiene: covering the mouth and nose when coughing or sneezing; using a tissue when possible; disposing of dirty tissue promptly are carefully – bag and bin • Avoiding non essential travel: non-attendance at large gatherings such as concerts, theatres, cinemas, sports arenas etc 15
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  17. 17. Public health interventions Population-wide interventions • Travel restrictions • Restrictions of mass public gatherings • Schools’ closures • Voluntary home isolation of cases • Voluntary quarantine of contacts of known cases • ?? Screening of people entering UK ports Antiviral drugs – for treatment of cases Likely to be only major medical countermeasure available early in a pandemic Used in the absence of, or as an adjunct to vaccination UK has stockpile of 14.6 million treatment courses Reproduced with permission from Roche Products Ltd. Tamiflu ® Some limited use as prophylaxis, if expert advice suggests appropriate Prioritisation only when becomes scarce 17
  18. 18. Vaccine • No vaccine ready to protect against pandemic flu (new virus) • Specific vaccine cannot be made until the virus has been identified • Cannot be predicted in same way as seasonal flu • Seasonal flu vaccine will not provide protection • Advance work is being done to facilitate production of a pandemic vaccine once the virus is known • Four to six months to develop, possibly longer • Plus more than 12 months for enough for UK population to be manufactured • When available, aim to immunise whole population as soon as possible • Vaccines will be given to some groups before others according to nationally agreed priorities • H5N1 vaccine may be used for HCWs (3.5 million doses purchased) 18
  19. 19. Sources of information Cabinet Office – Health Protection Agency – Department of Health – Health and Safety Executive – pandemic.htm WHO – ECDC – CDC (USA) – Pandemic influenza Sessions 2 and 3 Dr Quentin Sandifer Deputy Regional Director of Public Health NHS South East Coast Honorary Clinical Senior Lecturer University of Kent September 2008 19
  20. 20. SARS in Toronto • High rates of staff absenteeism • Complete workplace closure • Loss of key staff and knowledge • Reduced delivery to customers • Travel and meeting disruption • Supply chain disruption • Increased demand for some services (eg internet access and technical support to home workers) • Decreased demand for some products and services $2bn lost revenue 20
  21. 21. SARS in Toronto 251 cases and 43 deaths verified Building resilience in today’s business Focus of sessions - Business Impact and Response Impacts - Economic and Staff Response - Planning to stay in business 21
  22. 22. Business Continuity Management Planning to ensure that your organisation has a relatively quick and painless return to “business as usual” in the event of a major disruption, regardless of the cause. Why? • To protect your business by planning to stay in business • To protect your most important assets - your people • To protect the reputation of your business • To protect and enhance your profitability • To ensure compliance and secure recognition for your business 22
  23. 23. Principles of BCM 1. One basic plan 2. Focus on the response to the incident not its cause 3. Response arrangements must be fully integrated into the organisation’s structure - build-ons not add-ons 4. Activities of different organisational units must be integrated 5. Your plans should be co-ordinated with the plans of others Pandemic flu planning should be an extension of your business continuity plans 23
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  25. 25. Potential impact UK-wide 25-50% of population symptomatic 50,000-750,000 deaths 15-30% absent from work at peak £1242bn cost to society 25
  26. 26. Demand effects across industries Assumed declines in demand by industry during a severe flu pandemic Source: Trust for America's Health Cumulative 3 month loss in Industry/Government demand over course of a year agriculture, forestry, fishing and hunting 10% mining 10% utilities 0% construction 10% manufacturing 10% wholesale trade 10% retail trade 10% transportation and warehousing 67% information 0% financial services 10% real estate, rental and leasing 0% professional and technical services 0% corporate management 0% administrative services 0% educational services 10% health and social care -15% arts and entertainment, including sports and leisure 80% hotel and food services 80% other services, except government 5% government services 0% Why staff will be absent • They are ill with flu • They need to care for people who are ill • They need to care for (well) children • They have non-flu medical problems • They have been advised to work from home • They absent themselves for other reasons 26
  27. 27. Estimates of absenteeism Communication is everything! • Agree the message • Decide how you will communicate the message • Decide how you invite staff • Agree who will speak and make sure they are well briefed 27
  28. 28. Possible issues and questions • Employment • Medical countermeasures • Services and working - duty of care Pandemic influenza Appendices September 2008 28
  29. 29. Business continuity management Key headings • Business processes • Emergency response • Personnel • Premises and facilities • Information systems and internal communications • Public relations and external communications • Insurance • Financial • Legal Business continuity management Key resources (of the organisation) • Staff • Property and equipment • Services - power, heating, light, water etc • Technology - IT and telecommunications • Paper records and filing system 29
  30. 30. Business continuity management Key issues • Risk assessment and business impact assessment • Immediate response and what takes priority • Duration of disruption • Support to staff • Storage and security of data • Alternative sites of working, including home working • Dealing with external agencies LUNCH Pandemic Flu - Preparing Your Business A one-day workshop held at the Royal Society of Medicine • Thursday 11 September 2008 30
  31. 31. Pandemic influenza exercise Dr James Sedgwick Dr Quentin Sandifer September 2008 Introduction • Groups • Timings • Scenarios • Video • Questions • Feedback 31
  32. 32. Section one Questions 1. What plans are in place within your organisation to deal with pandemic flu? a. Who is responsible for pandemic flu (and/or business continuity) planning? b. If no specific plans are in place, what other plans or policies do you have? c. What planning guidance are you aware of in your business sector? 2. Would any existing plans be activated at this point? a. If not now, when? 3. What communications will be issued to staff at this point and how will this be done? 4. What would you advise your staff about international (and other) travel? a. Where could you get advice about this? Other questions and/or issues to take away 5. What are the critical activities for your organisation? 6. Do your suppliers/subcontractors have robust business continuity plans? 7. What are the Local Resilience Forum’s plans for responding to a pandemic? Section two Questions 1. What infection control procedures will be implemented in your workplace? 2. What arrangements have been made with regard to personal protective equipment? 3. What changes to working arrangements will be made to reduce the risk of transmission within the workplace? Other questions and/or issues to take away 1. What occupational health arrangements are in place for your staff? a. What is the occupational health / sick leave policy during a flu pandemic? 2. How will your staff who are ill get access to antivirals? 3. What communications will be issued to staff at this point and how will this be done? 32
  33. 33. Section three Questions 1. What will your organisation do about staff shortages? a. Do all areas of your organisation have nominated deputies for key employees in case of absence? b. Where would your organisation look for additional resources? c. What actions could you take to maximise staff resources? d. What steps could be taken to accommodate employees who have difficulties with childcare or sick family members? e. How does your organisation monitor staff absence? f. What is the legal position regarding staff who refuse to work? 2. How will disruption in utility services (transport, fuel, power, water, etc) effect your organisation? 3. What actions can you take to minimise this disruption? Other questions and/or issues to take away 4. How will staff shortages specifically affect the critical services in your organisation? Section four Questions 1. What are the priority areas for your organisation in terms of a return to normal business? 2. What actions would your organisation need to take to: 1. Return to normal business? 2. Prepare for a second wave? 3. What arrangements are in place to deal with staff health and welfare issues following a pandemic? 33
  34. 34. Conclusion • Exercise debrief • Lessons learned/identified - List three things that you are going to do when you return to your organisation in order to prepare for a flu pandemic. • Wrap up Q&A THANK YOU! Pandemic Flu - Preparing Your Business A one-day workshop held at the Royal Society of Medicine • Thursday 11 September 2008 34